Blog | Friday, January 3, 2014

Counting doctors or making doctors count


An article in Health Affairs by Thomas Bodenheimer and Mark Smith (Health Affairs, November 2013; 32:11, 1881-1886) addressed a timely and important issue: assessing the needed size of the primary care physician workforce. I found the article particularly relevant, since our medical group is grappling with this question right now, and it challenged me to think about the question differently.

Most of us have heard some dire prediction about a coming crisis in primary care, brought about by the collision of several trends: an aging population requiring more care; a surge in insured patients accessing primary care for the first time; a fall in the number of graduating students choosing primary care career options; declining work hours for established physicians who are leaving private practice for employment; the aging physician workforce. Add it all up, and it seems pretty grim, and hard to imagine that there will be enough primary care physicians around to meet the demand.

What Bodenheimer and Smith point out effectively is that the “physician shortage” is as much a consequence of how we organize primary care as it is about the number of doctors available. They calculate that more effective team based care, utilizing other clinicians such as nurse practitioners as well as other licensed (RN, PharmD) and unlicensed personnel (medical office assistants) can liberate physicians from spending time on tasks that others can do, thereby increasing capacity in their practices without adding more physicians. That is, it is all about making the doctors count, not about counting doctors.

Another paper in the same issue offered a link to an on-line tool that allows the user to vary assumptions about the extent to which care model redesign will take hold, and visualize the attendant consequences for the needed medical work force. Bottom line—pretty reasonable changes can make the doctor shortage go away.

Of course, all this depends on the extent to which physicians embrace working in a new way, and the acceptance of team-based care by patients. I am betting that the patients will be just fine with it, but the doctors will be slow to adapt.

Ira S. Nash, MD, FACP, is the senior vice president and executive director of the North Shore-LIJ Medical Group, and a professor of Cardiology and Population Health at Hofstra North Shore-LIJ School of Medicine. He is Board Certified in Internal Medicine and Cardiovascular Diseases and was in the private practice of cardiology before joining the full-time faculty of Massachusetts General Hospital. He then held a number of senior positions at Mount Sinai Medical Center prior to joining North Shore-LIJ. He is married with two daughters and enjoys cars, reading biographies and histories, and following his favorite baseball team, the New York Yankees, when not practicing medicine. This post originally appeared at his blog, Ausculation.